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PubMed1995

The application of continent urinary stomas to bladder augmentation or replacement in the failed exstrophy reconstruction.

OBJECTIVE: To determine the application and success of continent urinary stomas in the failed bladder exstrophy reconstruction. PATIENTS AND METHODS: A total of 35 patients underwent construction of a continent urinary stoma during bladder replacement or bladder augmentation between 1987 and 1993. The continent stoma was constructed with appendix (19 patients), tapered ileum (2), Benchekroun (12), Indiana (1) and Mainz type stoma (1). RESULTS: Three patients required revision of their continent stoma, one for incontinence and two for difficulty in catheterization. Overall, 95% experienced daytime continence on an intermittent catheterization regimen, while 90% were dry at night. The upper tract remained normal in 34 of 35 patients. CONCLUSIONS: While the Benchekroun technique is reliable in producing continence, difficulty with catheterization has been a chronic problem due to stomal stenosis. Our positive experience with using the appendix as a catheterizable conduit into either the bladder template or bowel segment has led us to prefer this method of continent stoma construction in the patient with a failed exstrophy. In the absence of an appendix, our preference is a tapered ileal segment. The failed exstrophy reconstruction can be salvaged with a continent stoma and substitution or augmentation cystoplasty in most patients, thus avoiding urinary diversion.

Adolescent↗
PubMedDate not supplied

[Further experience with the use of gastrointestinal segments in bladder reconstruction in the complex of exstrophy-epispadias].

It is a matter of discussion if bladder augmentation should or should not utilize in the treatment of exstrophy-epispadias complex. When staged functional bladder reconstruction is adopted in the most difficult cases, or when one desires to avoid early and/or subsequent urinary diversions, sometimes a bladder enhancement could be necessary. The indications should be: a progressive damage to the upper urinary tract, after bladder closure at birth, due to a very small, no compliant detrusor plate (this is a rare condition: only one case in our series); a bladder capacity < or = 80 mls at the time of bladder neck reconstruction (this is a frequent but questionable condition: three cases in our series); a progressive damage of the upper urinary tract after bladder neck reconstruction (this is an unexpected, but not rare condition: 3 cases in our series); during every undiversion procedure (bladder augmentation is nearly mandatory during undiversion in cloacal or bladder exstrophies previously diverted: 4 cases in our series). In our experience, 12 bladder augmentations (in 11 patients, over 85 cases we observed) were done at median age of 8 years and 5 months. Different intestinal segments have been used: the sigmoid colon, the ileo-cecal portion, an ileal tract and the stomach. Follow-up ranges from 11 years to 12 months; until now, we observed few surgical complications: a bowel obstruction in one patient, a left ureteral partial stenosis at level of the anastomosis with the gastric patch wall in another patient and bladder lithiasis in 5 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Cystoplasties in children].

Whenever the reservoir function of the bladder is impaired (neuropathic bladder and exstrophy), an enterocystoplasty constitutes a satisfactory solution in children to enlarge the bladder. The various techniques must take into account the degree of alteration of the bladder. The bowel segment must be detubularized, regardless of its origin. The main challenge is to obtain adequate peripheral resistance with easy voiding and filling of the bladder without urine leak, particularly in boys. In girls, the combination of enterocystoplasty and Gobbel-Stockel procedure ensures perfect continence between two self-catheterisations.

Bladder Exstrophy↗
PubMed2004

Left-sided gastroschisis and pseudoexstrophy: a rare combination of anomalies.

Pseudoexstrophy is a rare variant of the exstrophy/epispadias complex, comprised of the musculoskeletal defects of classic exstrophy but with an intact bladder and urethra. We present a case of a neonate with left-sided gastroschisis and pseudoexstrophy, the first reported combination of these two anomalies. The anomalies in this case were unusual but highlight the importance of careful clinical evaluation before and during surgery so as to carefully define the anatomy of the abnormalities, which will assist in planning surgery and further postoperative management. Identifying and reporting these unusual cases is essential to further expand our understanding of these conditions and their potential associations.

Bladder Exstrophy↗
PubMedDate not supplied

[Exstrophy].

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Bladder Exstrophy↗
PubMed1993

Ureterocystoplasty: a unique method for vesical augmentation in children.

Vesical augmentation may be accomplished by using small bowel, large bowel or stomach, and by detrusor myotomy or the autoaugmentation technique. The use of intestinal segments is associated with variable mucus production, electrolyte absorption and the risk of malignant transformation. Autoaugmentation is free of these potential risks but may be unsuccessful in creating sufficient improvement in vesical compliance and capacity. Ureterocystoplasty with a bladder based native ureteral flap has been used in neurovesical dysfunction in association with a nonfunctional refluxing kidney, in a noncompliant valve bladder associated with posterior urethral valves and a nonfunctional kidney, and in augmentation of a small bladder after closure of cloacal exstrophy. Adequate bladder capacity and compliance have been achieved without the use of extra urinary epithelium. The surgical approach is simple and uncomplicated. Ureterocystoplasty in selected cases will provide for adequate bladder capacity and compliance when augmentation cystoplasty is required.

Child↗